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Proinflammatory state and circulating erythropoietin in persons with and without anemia.
Am J Med. 2005 Nov; 118(11):1288.AJ

Abstract

PURPOSE

High circulating levels of proinflammatory cytokines cause anemia, perhaps by interacting with erythropoietin production or biological activity. We characterize the relationships of systemic inflammation, erythropoietin, and hemoglobin.

METHODS

Data are from the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study population. A sample of 1270 persons aged 65 years or older and 30 men and 30 women from each age-decade 20 to 70 years were randomly selected from the residents in the Chianti, Italy, geographic area. Of the 1714 eligible persons, 1235 had complete data on inflammatory markers, erythropoietin, hemoglobin, potential causes of anemia, and other relevant covariates. Anemia was defined as hemoglobin less than 12 g/dL in women and less than 13 g/dL in men.

RESULTS

Independent of age, sex, and hemoglobin, the number of elevated inflammatory markers (C-reactive protein, interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha) was associated with progressively higher erythropoietin in non-anemic participants but lower erythropoietin in anemic participants. Findings were consistent across different causes of anemia. The threshold at which the effect of inflammation on erythropoietin reversed was close to 13.0 g/dL of hemoglobin.

CONCLUSIONS

Our findings suggest that anemia of inflammation evolves from a "pre-anemic" stage characterized by a compensatory increment of erythropoietin that maintains normal hemoglobin levels to a stage of clinically evident anemia in which erythropoietin levels are not high enough to maintain normal hemoglobin, possibly because of the inhibitory effect of inflammation on erythropoietin production. This hypothesis requires testing in a longitudinal study.

Authors+Show Affiliations

Clinical Research Branch, National Institute on Aging, Longitudinal Studies Section Clinical Research Branch, ASTRA Unit, Harbor Hospital Baltimore, Md 21225, USA. ferruccilu@grc.nia.nih.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16271918

Citation

Ferrucci, Luigi, et al. "Proinflammatory State and Circulating Erythropoietin in Persons With and Without Anemia." The American Journal of Medicine, vol. 118, no. 11, 2005, p. 1288.
Ferrucci L, Guralnik JM, Woodman RC, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med. 2005;118(11):1288.
Ferrucci, L., Guralnik, J. M., Woodman, R. C., Bandinelli, S., Lauretani, F., Corsi, A. M., Chaves, P. H., Ershler, W. B., & Longo, D. L. (2005). Proinflammatory state and circulating erythropoietin in persons with and without anemia. The American Journal of Medicine, 118(11), 1288.
Ferrucci L, et al. Proinflammatory State and Circulating Erythropoietin in Persons With and Without Anemia. Am J Med. 2005;118(11):1288. PubMed PMID: 16271918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proinflammatory state and circulating erythropoietin in persons with and without anemia. AU - Ferrucci,Luigi, AU - Guralnik,Jack M, AU - Woodman,Richard C, AU - Bandinelli,Stefania, AU - Lauretani,Fulvio, AU - Corsi,Anna Maria, AU - Chaves,Paulo H M, AU - Ershler,William B, AU - Longo,Dan L, PY - 2004/12/31/received PY - 2005/06/17/revised PY - 2005/06/17/accepted PY - 2005/11/8/pubmed PY - 2005/12/13/medline PY - 2005/11/8/entrez SP - 1288 EP - 1288 JF - The American journal of medicine JO - Am J Med VL - 118 IS - 11 N2 - PURPOSE: High circulating levels of proinflammatory cytokines cause anemia, perhaps by interacting with erythropoietin production or biological activity. We characterize the relationships of systemic inflammation, erythropoietin, and hemoglobin. METHODS: Data are from the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study population. A sample of 1270 persons aged 65 years or older and 30 men and 30 women from each age-decade 20 to 70 years were randomly selected from the residents in the Chianti, Italy, geographic area. Of the 1714 eligible persons, 1235 had complete data on inflammatory markers, erythropoietin, hemoglobin, potential causes of anemia, and other relevant covariates. Anemia was defined as hemoglobin less than 12 g/dL in women and less than 13 g/dL in men. RESULTS: Independent of age, sex, and hemoglobin, the number of elevated inflammatory markers (C-reactive protein, interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha) was associated with progressively higher erythropoietin in non-anemic participants but lower erythropoietin in anemic participants. Findings were consistent across different causes of anemia. The threshold at which the effect of inflammation on erythropoietin reversed was close to 13.0 g/dL of hemoglobin. CONCLUSIONS: Our findings suggest that anemia of inflammation evolves from a "pre-anemic" stage characterized by a compensatory increment of erythropoietin that maintains normal hemoglobin levels to a stage of clinically evident anemia in which erythropoietin levels are not high enough to maintain normal hemoglobin, possibly because of the inhibitory effect of inflammation on erythropoietin production. This hypothesis requires testing in a longitudinal study. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/16271918/Proinflammatory_state_and_circulating_erythropoietin_in_persons_with_and_without_anemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(05)00503-6 DB - PRIME DP - Unbound Medicine ER -